My Three Favorite Assessment Questions


One of the things that separates average clinicians from great ones is how quickly they complete assessments.  I have been fortunate to have worked with a few great ones, and was always amazed at how much information they would obtain from patients after asking only a few questions.  Now I teach students to pretend each assessment question will be the last one they get to ask before their patient becomes unconscious.  This forces them to think about what information is most important about a particular complaint.

Here are three of my favorite questions, and I use some form of them on almost every patient:

1. When did this start? 

After introducing myself and asking what’s wrong, this is almost always my second question. It sets the pace for the rest of the call, and is an indicator of how much time we have to formulate a treatment plan.  If a patient’s breathing difficulty came on right before they called, and they are unable speak more than a few words at a time, we know they are sick need to act quickly.  If their complaint as gradually gotten worse over a longer period of time, we usually have some time to get more information before intervening.  This does not mean that they are not sick, only that we have time to probe deeper to find out how sick they might be.

2. Has this happened before?  

I usually ask some form of this question third, and usually the answer is yes.  Then I ask if they went to the hospital or saw their doctor the last time this happened.  When they have, we can usually get a good idea about what is wrong with them.  I also pay close attention to what the patient thinks is wrong, since they know their bodies much better than we ever will.  Another word of caution, though, doctors do get it wrong sometimes.  One patient told me that she was diagnosed with bronchitis the last time she passed out, and was in V-tach when I put her on the monitor. You can usually trust a past diagnosis being right, but you must always verify with your own assessment.

Do you have pain anywhere?

This one is my favorite.  It was used a lot by one of my paramedic partners when I was a new EMT, and remember how effective it was the first time I heard him ask it.  When given the choice of answering yes-or-no to assessment questions, many patients automatically answer “yes” to everything.  I have found this open-ended question is particularly useful at narrowing complaints down into one body system.  If they have pain “all over,” I ask where it is the worst and where it started.  If any complaint sounds like it may be a heart problem, but the patient denies or does not mention chest pain, I follow up by asking if anything in their chest feels unusual.   I hate hearing patients say  “now that you mention it…” in triage.  That question has prevented that from happening more than a few times.

Assessment skills are used on every patient, and just as important as any practical skill we perform.  What are your favorite questions?

Comments

  1. Gregg The BLS Guy says:

    Great post. I’m going to use this tomorrow at work and see how it goes.

  2. I have used those questions for years and find them to be very effective. The first two are generally in my initial questionning/assessment. The third one tends to vary when it gets asked depending on the patient and/or situation.

    I really like the teaching tool (ask each question as if it’s your last) and, I hope you don’t mind, but I would like to use it with my students.

  3. “How does your chest feel?” is how I handle the chest. “Is anything else bothering you?” is a good catch-all too. And I agree that relating symptoms to previous experiences helps a lot; if it’s totally new that’s helpful, but if it’s similar to a previous episode that’s also helpful, because you can ask what the diagnosis was then, whether this is worse or better, etc. Even a very unimpressive presentation is alarming to me if it’s “just like the last time I had a heart attack.” Like you said, people are the experts about their own bodies.

    I also like to ask, particularly for patients who insist everything’s been well recently, when the last time they visited the hospital was. Usually it wasn’t very long ago, then you can ask why, and that gives a good insight into their recent status. This segues well — you can ask where they usually go/want to go when it comes to transport decisions, then ask when they were last there, etc.

  4. “what did the last paramedic do?” I kid, and Im currently only a student. But I do a pt transfer job for income and we do some what of an assessment for the job. I cant agree more with let them tell you whats going on in their body. Some people can be very descriptive and narrow it right down for you.

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